Healthcare Provider Details

I. General information

NPI: 1215937453
Provider Name (Legal Business Name): CHONA CUDAL FERNANDEZ-GULMATICO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 EMMONS AVE
BROOKLYN NY
11235-1709
US

IV. Provider business mailing address

3103 EMMONS AVE
BROOKLYN NY
11235-1709
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-2000
  • Fax: 718-240-2260
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number188438-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number188438-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: